Universal newborn hearing screenings (UNHS) play an essential role in identifying hearing loss present at birth. Children whose hearing loss is progressive, fluctuating or acquired however, are not detected by UNHS, the prevalence of which doubles up until school-entry age. Routine ear health and hearing checks play an essential role in diagnosing and rehabilitating hearing problems, particularly for Aboriginal and Torres Strait Islander families. However, the standard models for population-based school hearing screenings are ubiquitously lacking in data capture, monitoring and follow-up procedures when a hearing loss is identified. The pilot study, Little Ears Big Impact (LEBI), seeks to address these issues by working in collaboration with Wellbeing and Health In-Reach (WHIN) nurses. LEBI takes a targeted approach to school-based hearing screens, by identifying and screening children with hearing, language, behavioural or developmental concerns. The LEBI program, by utilising the WHIN, was able to engage with families in 80% of cases when a hearing loss was identified. Furthermore, unlike other school-based hearing screening programs reported in the literature, the LEBI study achieved up to 93% adherence to referrals, and up to 96% resolution of hearing problems (following intervention) for these identified students. The LEBI pilot program has demonstrated, through a collaborative and targeted approach to hearing screening, an effective means of increasing rates of intervention and resolution of hearing problems for vulnerable students and families.